Iop part 2  - co-occurring diff dx and self med
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    Iop part 2  - co-occurring diff dx and self med Iop part 2 - co-occurring diff dx and self med Presentation Transcript

    • IOP Part 2: Co-Occurring Disorders,Self-Medication andPhysiological Effects of Addiction
    • Review of Last Week0 We talked about the basics of addiction0 How will life be different when you are sober0 Review your journal and tell the group about 3 things that made you feel 0 Angry/Frustrated/Irritated/Resentful 0 Happy/Grateful 0 Anxious/Stressed0 Do the things that led to negative feelings have anything in common? (Out of your control, Failure, the Unknown, Rejection…)
    • Objectives0 Define Co-Occurring Disorders0 Identify the symptoms of the most common mental health issues0 Discuss how substances may be used to self-medicate mental health issues0 Discuss medical conditions and how they may mimic mental health issues0 Identify how certain medications can produce symptoms of depression or anxiety0 Understand why a bio-psycho-social approach to recovery is so important
    • AD/HD0 DSM-IV Diagnostic Criteria for ADHD Either (1) or (2): 0 Six (or more) symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level: 0 Often fails to pay attention to details or makes careless mistakes 0 Often has difficulty sustaining attention in tasks or play activities 0 Often does not seem to listen when spoken to directly 0 Often does not follow through on things 0 Often has difficulty organizing tasks and activities 0 Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) 0 Often loses things necessary for tasks 0 Is often easily distracted by extraneous stimuli 0 Is often forgetful in daily activities
    • 0 6 of the following symptoms of hyperactivity- impulsivity have persisted for at least 6 months and are inconsistent with developmental level: Hyperactivity 0 Often fidgets with hands or feet or squirms in seat 0 Often leaves seat in classroom or in other situations in which remaining seated is expected 0 Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be feelings of restlessness) 0 Has difficulty playing or engaging in leisure activities quietly 0 Is often "on the go" or often acts as if "driven by a motor" 0 Often talks excessively
    • 0Impulsivity 0Often blurts out answers before questions have been completed 0Often has difficulty awaiting turn 0Often interrupts or intrudes on others0 Some symptoms that caused impairment were present before age 7 years.0 Impairment is present in two or more settings0 Clinically significant impairment
    • Adult AD/HD0 Adult symptoms 0 Hyperactivity and poor concentration 0 Affective 0 Lability/Hot temper 0 Inability to complete tasks and disorganization 0 Stress intolerance 0 Impulsivity
    • Axis I: Mood Disorders Part A: Anxiety
    • Anxiety: Generalized0 At least 6 months of "excessive anxiety and worry" about a variety of events and situations.0 There is significant difficulty in controlling the anxiety and worry.0 The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms: 0 1. Feeling wound-up, tense, or restless 0 2. Easily becoming fatigued or worn-out 0 3. Concentration problems 0 4. Irritability 0 5. Significant tension in muscles 0 6. Difficulty with sleep0 The symptoms are not part of another mental disorder.0 The symptoms cause "clinically significant distress“0 The condition is not due to a substance or medical issue
    • Anxiety: Panic Disorder0 Symptoms 0 A discrete period of intense fear/discomfort, in which 4 of the following developed abruptly and peaked within 10 minutes: 0 palpitations, pounding heart, or accelerated heart rate 0 sweating 0 trembling or shaking 0 sensations of shortness of breath or smothering 0 chest pain or discomfort 0 nausea or abdominal distress 0 feeling dizzy, unsteady, lightheaded, or faint 0 derealization (feelings of unreality) or depersonalization (being detached from oneself) 0 fear of losing control or going crazy 0 fear of dying 0 paresthesias (numbness or tingling sensations) 0 chills or hot flushes
    • Anxiety: PTSD0 Symptoms 0 The person has been exposed to a traumatic that involved actual or threatened death or serious injury, or a threat to self or other and the persons response involved intense fear, helplessness, or horror. 0 The traumatic event is persistently reexperienced in one (or more) of the following ways: 0Dreams 0Flashbacks 0Intense distress at exposure to reminders of the event
    • PTSD cont…0Avoiding reminders of the trauma and numbing of general responsiveness (not present before the trauma): 0efforts to avoid thoughts, feelings, or conversations associated with the trauma 0efforts to avoid activities, places, or people that arouse recollections of the trauma 0inability to recall an important aspect of the trauma 0markedly diminished interest or participation in significant activities 0feeling of detachment or estrangement from others 0restricted range of affect (e.g., unable to have loving feelings)
    • PTSD cont…0 Persistent symptoms of increased arousal (not present before the trauma) 0difficulty falling or staying asleep 0irritability or outbursts of anger 0difficulty concentrating 0hypervigilance 0exaggerated startle response
    • Axis I: Mood Disorders Part B: Depression
    • Depression and Dysthymia0 Major Depressive Episode 0 A. Five (or more) of the following have been present nearly every day during the same 2-week period 0 depressed mood most of the day 0 markedly diminished interest or pleasure in all, or almost all, activities 0 significant changes in eating patterns. 0 insomnia or hypersomnia 0 psychomotor agitation or retardation nearly every day 0 fatigue or loss of energy 0 feelings of worthlessness or excessive or inappropriate guilt 0 diminished ability to think or concentrate, or indecisiveness, 0 recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
    • Depression cont…0 The symptoms are not due to 0 the direct physiological effects of a substance 0 a general medical condition (e.g., hypothyroidism). 0 Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation0 Dysthymia is a constant, low-grade depression that lasts for months or years.
    • Bipolar0 Disorder in which the person experiences both manic and depressive type symptoms0 Symptoms can alternate, co-occur(mixed) or be present to a greater or lesser degree (hypomania/dysthymia)
    • Mania0 Abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week 0 inflated self-esteem or grandiosity 0 decreased need for sleep more talkative than usual or pressure to keep talking 0 flight of ideas or subjective experience that thoughts are racing 0 distractibility 0 increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 0 excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
    • Hypomania0 Criteria for Hypomanic Episode (DSM-IV, p. 338) 0 The manic episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
    • Medical Disorders0 Depressive-Like Symptoms 0 Diabetes 0 Hypothyroid 0 Fibromyalgia 0 Chronic Fatigue0 Manic-Like Symptoms 0 Hyperthyroid
    • SummaryDepressive & Bipolar Disorders0 Depression0 Dysthymia0 Mania0 Hypomania0 Bipolar I0 Bipolar II0 Cyclothymia0 Differential Diagnosis
    • Physical Issues0 Physical conditions can mimic intoxication or withdrawal0 Physical conditions can worsen during use or withdrawal0 People use to self-medicate physical (and emotional) conditions0 Effective treatment involves addressing physical AND emotional conditions AND treatment side effects which are unplesant.
    • Substances and Medications0 Depression 0 Opiates 0 Anxianxiety/Benzodiazepines 0 Depressants/Barbiturates 0 Inhalants 0 GHB0 Mania 0 Ecstasy/MDMA 0 Methamphetamine 0 Cocaine 0 Steroids
    • Medications0 Pain killers (opiates) and antianxiety medications (benzodiazepines) can produce feelings of tiredness, sluggishness and general apathy.0 Stimulants (decongestants, ADD/ADHD medications) can cause nervousness, shakiness and anxiety-like symptoms. Excessive use can cause depression-like symptoms when not using0 Steroids can cause irritability, depression and dramatic mood swings
    • Medical Issues0 Chronic Fatigue 0 Dry mouth 0 Being dizzy when standing up, or 0 Fatigue having problems with balance and 0 Sore Throat fainting 0 Loss memory and loss of 0 Irregular heartbeats concentration 0 Ear aches 0 Enlarged lymph nodes in the neck 0 Morning stiffness 0 Muscle pain that is unexplained 0 Pain in your jaw 0 Joint pain that can move from joint 0 Nausea to joint without any signs or swelling. 0 Having night sweats and chills 0 Sleep that is unrefreshing and 0 Depression, anxiety, irritability, waking up as tired panic 0 Headaches 0 Being short of breath 0 Exhaustion 0 Tingling Sensations in your extremities 0 Pain in the abdominal region 0 Vision blurring, eye pain, 0 Having allergies or other sensitivity to light or dry eyes. sensitivities 0 Gaining or losing weight. 0 Chest pains 0 Bloating/Diarrhea
    • Medical: Diabetes0 Diabetes 0 Type 1 Diabetes 0 Frequent urination 0 Unusual thirst 0 Extreme hunger 0 Unusual weight loss 0 Extreme fatigue and Irritability 0 Mimics depression
    • Medical: Diabetes0 Hypoglycemia 0 nervousness 0 sweating 0 intense hunger 0 Trembling 0 weakness 0 Palpitations 0 Trouble speaking/Word Slurring0 Mimics anxiety disorders
    • Medical: Fibromyalgia0 Chronic muscle pain, muscle spasms or tightness0 Moderate or severe fatigue and decreased energy0 Insomnia or waking up feeling just as tired0 Difficulty remembering, concentrating0 Tension or migraine headaches0 Jaw and facial tenderness0 Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold0 Feeling anxious or depressed0 Numbness or tingling in the face, arms, hands, legs, or feet0 A feeling of swelling (without actual swelling) in the hands and feet
    • Medical: Hypertension0 Hypertension 0 Severe headache 0 Fatigue or confusion 0 Vision problems 0 Chest pain 0 Difficulty breathing 0 Irregular heartbeat 0 Blood in the urine 0 Pounding in your chest, neck, or ears If you have any of these symptoms, see a doctor immediately. You could be having a hypertensive crisis that could lead to a heart attack or stroke.
    • Medical ArrhythmiasSymptoms of Arrhythmias0 Palpitations (a feeling of skipped heart beats, fluttering or "flip-flops," or feeling that your heart is "running away").0 Pounding in your chest.0 Dizziness or feeling light-headed.0 Fainting.0 Shortness of breath.0 Chest discomfort.0 Weakness or fatigue (feeling very tired).
    • Medical: Heart Disease0 Shortness of breath0 Palpitations0 A faster heartbeat0 Weakness or dizziness0 Nausea0 Sweating
    • Polycystic Ovarian Syndrome0 Infrequent, absent, and/or irregular menstrual periods0 Increased hair on the face, chest, torso, thumbs, or toes0 Cysts on the ovaries0 Acne, oily skin, or dandruff0 Weight gain or obesity, usually around the waist0 Male-pattern baldness or very thin hair0 Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black0 Pelvic pain0 Anxiety or depression
    • Medical:Thyroid Hyperthyroid HypoThyroid0 Palpitations 0 Fatigue0 Heat intolerance 0 Weakness0 Nervousness 0 Weight gain0 Insomnia 0 Coarse, dry hair0 Breathlessness 0 Dry, rough pale skin0 Increased bowel movements 0 Hair loss0 Light or absent menstrual periods 0 Cold intolerance (you cant0 Fatigue tolerate cold temperatures like0 Fast heart rate those around you)0 Trembling hands 0 Muscle cramps/muscle aches0 Weight loss 0 Constipation0 Muscle weakness 0 Depression0 Warm moist skin 0 Irritability0 Hair loss 0 Memory loss0 Staring gaze 0 Abnormal menstrual cycles 0 Decreased libido
    • Axis III: Medical Issues--- Summary0 Many medical conditions have symptoms that mimic substance abuse or mood disorders0 Side effects of medications can also mimic substance abuse0 Some people self medicate physical and/or emotional issues with substances
    • Homework0 Family History: 0 Identify each person in your family from your grandparents and great aunts and uncles to your parents and siblings. 0 List any medical or mental health problems they had, or you suspect they had0 Identify 2 simple things that you can do each day to help you feel better 0 Example: 0 I watch the birds that come to my feeder and play with my pets. Sometimes I garden. 0 I get better rest if I am on a schedule and go to bed at the same time each night.